Date of Award

5-11-2020

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

First Advisor

Shelley Margot Kierstead

Abstract

This dissertation is a comprehensive study of the new legal framework for the long-term care (LTC) sector (also known as nursing homes) in Ontario, Canada. The research sought to answer the following question: What are the potential implications for persons with disabilities of the changes made by the Government of Ontario between 2004 and 2018 to the legislation and governance of treatment, care and living circumstances within LTC homes? LTC is where many older women with disabilities and serious illnesses experience care. This study brings a gendered disability perspective to a public policy issue that is usually singularly associated with aging. To theorize the regulation and provision of care in LTC, the author situates LTC research within debates about care in disability scholarship. The concept of caring relationships is used to draw out tensions inherent in receiving and delivering care. Caring relationships are shaped by, among other political and market forces, the legal and administrative structure of a benefit scheme or a regulatory regime. The New Governance literature is employed to describe and examine new processes and procedures that shape caring relationships in LTC. To create a more comprehensive account of the changes, the research methods used were document review, legal analysis and key informant interviews. The feminist political economy literature was relied upon to draw out critical insights about the LTC sector. The majority of changes identified in the review were the creation of new or the strengthening of existing processes. The few substantive changes can be described as fragmented efforts to reduce risks to the safety, physical survival and security of individual residents. These changes if properly understood and implemented are significant in that they afford more procedural protections to residents in caring relationships and allow residents to make claims for inclusion and participation in making care decisions and in influencing conditions within the home. However, the mechanisms were designed without careful consideration of how the actual circumstances of residents, connected to the intermeshing of disability, gender and age, will impact their proper implementation. Consequently, some LTC applicants and residents cannot benefit from the protections offered by the law.

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